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Christine Ko: A Dermatopathologist’s Perspective on Healthcare

In this episode of the Perspectives on Healthcare Podcast, Christine Ko joins Rob Oliver to share a dermatopathologist’s perspective on healthcare. Based in Connecticut, Christine Ko is both a dermatologist and a dermatopathologist. She is a member of Generation X.

Here are 3 things that stood out to me as Christine Ko presented a dermatopathologist’s perspective on healthcare:

· Sometimes doctors are patients too! (Sometimes they are the parents of patients…)
· Getting the correct diagnosis quickly facilitates timely and proper treatment
· Why medical professionals need to figure out what color their patient’s eyes are

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Disclaimer: All opinions expressed by guests on the Perspectives on Healthcare Podcast are solely the opinion of the guest. They are not to be misconstrued as medical diagnoses or medical advice. Please consult with a licensed medical professional before attempting any of the treatments suggested.

Here is the transcript of the “Christine Ko: A Dermatopathologist’s Perspective on Healthcare” episode of the Perspectives on Healthcare Podcast:

Rob Oliver: Thank you. And I appreciate you being with me today. My perspective today comes from Christine Ko She is a dermatologist as well as a Dermatopathologist, and she I love this in her bio. She says she is sometimes a patient and is also the mother of a patient, which I think is such an important distinction to realize that even medical professionals where multiple hats, they sit on both sides of this stethoscope, so to speak. She is from Connecticut. She is a member of Generation X. Christine, thank you for being here.

Christine Ko: Thank you for having me. I feel honored. Absolutely.

Rob Oliver: Tell me a little bit about yourself and your role in health care.

Christine Ko: So as you said, I’m a physician, I’m a dermatologist ender Mata pathologist. And so my job is I work in health care and mainly continue my microscope actually behind me for anyone who’s looking at the video. And so I stand at my microscope and I look at slides. So if you’ve ever had a skin biopsy, that piece of skin gets sent to the lab and process and it gets put on a little microscopic slide, and then someone looks at it to make a diagnosis of whether you have a skin cancer like malignant melanoma or it’s benign and it’s just a mole, so called Nevis and medical speak. So that’s what I mainly do. I also do see page. And so mainly what I’m doing now is I’m examining patients who are post transplant, usually solid organ transplant, and because of the immune suppressive medicines, they’re on to prevent rejection of the new organ. They are at increased risk for skin cancer. So I’m examining their skin. I’m not taking care of their newly transplanted kidney or liver or lungs or whatever organ it might be. But that’s sort of what I do for my job. And then I have two kids. So I have gone through sort of prenatal care and postnatal care, and one of my children has had a significant medical issue. And so we had to encounter health care a lot from that. And I learned a lot and was humbled a lot by that experience. And so that’s sort of where today not always throughout my career. But today I’m highly influenced by those three aspects. Being a doctor, having been a patient myself, but pretty much sort of routine care and, you know, everything luckily went well with my pre and postnatal care and then being the mother of a patient. And actually, I guess I should also mention that we sort of encountered a delay and diagnosis. I’m not sure. I guess you could also may be classified as a misdiagnosis until we got the right diagnosis or a significant delay. And what I mean by a significant delay is that my son was diagnosed with a disease called auditory neuropathy when he was just about two years old. But I had been taking him to see the doctors and audiologists from nine months of age. It would have been better, I think, had he been diagnosed at nine months of age. But outcome wise things have turned out well, if you measure it by speech and language acquisition is all as well the envelope. But that has really influenced me thinking about diagnosis misdiagnosis and how as a doctor patient, a mother, a patient, I can perhaps influence that sort of outcome of getting the right diagnosis.

Rob Oliver: It’s interesting that you you combine all three of those together and you develop that empathy that says, listen, it’s not just about eventually ending up at the right diagnosis, but it’s getting the diagnosis right from the beginning, which then I’m assuming, does that lead into making sure that the treatment is right from the beginning?

Christine Ko: Absolutely. That’s exactly correct. I think the reason that we I guess I am super focused on diagnosis now is because it is tied to the right treatment and management. And so for a lot of things, like especially for dermatopathology, looking at the skin, they’re really small differences. Do you call it a benign? This for a non cancer kind of this, or do you call it a non cancer? A versus B, like Potato vs Potato, doesn’t really matter. It’s benign. Either way, the names we have are sometimes crazy. So meaning what I call it a separate keratosis or an epidermal tic a canola. It’s like they’re both benign. Who cares? Nothing happens to the patient. The patient doesn’t need any more treatment. So in that case, sometimes I’ll joke around with the trainees like we could just call it benign. Period. All that needs to happen. And then the dermatologist who do the biopsy communicate that to the patient, and it’s all fine. What we don’t want to do is give a diagnosis where the treatment is different significantly than what should ideally happen for the correct diagnosis. Meaning cancer versus not cancer is a good example. It’s really a cancer. But I say it’s not cancer. Then nothing’s happening to the patient. Like, no more treatment, usually for skin. If we cut a cancer out, it’s enough. Not always true for melanoma or some rare skin cancers like Merkel cell carcinoma, but and even some squamous cell carcinoma. But usually we can cut it out. So usually with a non cancer diagnosis, you just stay to the patient, okay? You’re fine. Nothing more needs to be done. So in that case, the tumor, the cancer would continue to grow and potentially cause harm. So luckily for me, I guess in skin say, for most cancers, basal cell carcinoma, squamous cell carcinoma, even if we aren’t, don’t give the diagnosis right away. Say it’s missed. For whatever reason, it just grows locally and oftentimes. Then just the bump. The tumor itself is larger and you can still cut it out and the patient is cured later. And there might be just local harm, psychologically and then just locally on the skin to the patient, meaning that maybe they have a larger scar. Maybe they had a lot of pain for that period of delay diagnosis that they didn’t need to, you know, things like that. But for the most part, they’re still cured. Melanoma is a little bit of an exception. I think malignant melanoma, like breast cancer, sometimes affects pretty young people, like even in their early twenties or even sometimes a little younger. It can metastasize spread to other parts of the body early on or you think you’re cured and later on it can spread. So in that sense, I think it’s a lot like breast cancer and also similar to breast cancer, in the sense that sometimes just literally like 10th of a millimeter of involvement of the skin makes a difference. And that’s just biologic. It’s not necessarily like anything that a doctor or the patient can do anything about, but we can try to get the diagnosis right, you know, correct right away.

Rob Oliver: Sure. What does quality health care mean to you?

Christine Ko: So I think that’s sort of what we’ve been touching around. I think quality health care to me is really treating patients right now, and I don’t mean only that sort of amusing. It in two different ways that treating part treating medically. But I also think psycho socially to sort of have a good connection between doctor and patient is increasingly important to me. And I think affects care actually more than I ever really realized as a medical student and sort of, I guess, young or junior physician. But I think when you think about just say, a parent child relationship, not that the doctor patient religions, anything really like that. But in the sense that parents are the adult and have more knowledge in general than a young child. Not that parents are always right and parents can get things wrong, too. But in that sense, the doctor usually has more knowledge about the medical specific things than a patient new, completely new to a diagnosis. Some patients, I will say a lot of patients are very smart once they start looking into and reading the correct thing, Garner a huge amount of knowledge. But I’m just saying initially, when you don’t even know you have something right. And if you have no background in health care, the doctor hopefully should know more than the patient and have that kind of sort of overarching perspective that hopefully a parent would have as well. Okay. This is what you have is what we’re going to do is how we can get through it and imagine, like, you know, the better the parent child relationship is. I think the smoother those things are and not that you can’t get through like you made everyone’s parents are not perfect. And I know I’m not a perfect parent, but it’s just they think easier. The more love there is an a parent child relationship. And so I think similarly, for doctor patient, I’m not sure I would necessarily call it love, but I think that kind of emotion that sort of you’re connected to me because I’m your doctor and I’m connected to you because I’m your patient. I think that having that and I think really between doctor and patient sort of relates to trust is really important and is part of getting patients treated correctly.

Rob Oliver: And in some ways, I’m thinking that there’s an old style parenting that would be kind of autocratic in nature, which also may have been what doctors had in the past, which is this is your diagnosis. And now I’m going to tell you what we’re going to do. And I’m not going to explain why I’m not going to give you any information, just this is the plan. And I know, but this is what we’re going to do. And I think that you’re likening it to parenting styles or the parenting relationship. There’s got to be not just the explanation of what the plan is moving forward. But as you share some of the why with the child with the patient, it’s going to expand that as well, increase respect and give them the knowledge that they have, give them the knowledge so that they can move forward in making decisions when the doctor is not there to give them that. I think we’ve kind of covered this, but it’s on my list. So can you give me an example of quality health care?

Christine Ko: Absolutely. So I was very lucky when my son was young to have found a superlative surgeon. And I mean superlative also in two ways. He’s technically excellent. And I found that out even sort of actually more later, after many years after my son had had surgery by him, but also just literally, when we were with him in the exam room, he just gave off such warmth and comfort to us. It was extraordinary. So examples would be my son at the time was just a little bit less than age two and so curious about everything. I mean, I think it was partially he couldn’t hear well or maybe not at all. And so he just loved to touch everything. And he actually loved to put stuff in his mouth, I think be also with his tongue and just a lot of people when we were going to these new visits, I don’t think he really understood where we were. It was he’d be very curious. He’s very happy, curious kid. And and so I remember he just wandering around this exam room and touching everything. And I was like chasing after him. And it was so interesting because this surgeon highly respected in the field, you know, technically excellent. He picks him up, and it’s just holding him. And I just was blown away by that. And then in addition to that, he answered my questions. And he said to me when I was bringing up some of my concerns, he said to me that he said, you are not alone. And it’s just I don’t know the degree of comfort that I derive from that because I was and I think it sounds, maybe almost. I don’t know. I shouldn’t. I have known that he’s there with me. But I guess I just hadn’t had that sense yet from the health care we received. And it might have not that it was necessarily anyone else’s failing. Don’t get me wrong. We had also seen some other very good. But that just was an example where I think just having the empathy and he could see my anxiety and worry. And he reached out in that sense. So not just from okay. This is the diagnose system. This is what we’re going to do when we do surgery. But he’s just like, it was kind of like, it’s going to be okay. And that was just so comforting. It was amazing. And this is a theme that I’m hearing recur, and that is excellent. Excellent quality health care takes into account not just the physical nature of what’s going on, but the the psychological and social implications of it as well. What do you wish people understood about your role in health care? So I try to tell my patients now more than ever that it’s a partnership. And if they have concerns, if they have questions, they have to let me know because I experiences I think patience, for the most part, are are kind as well. And the my patients are at least. And they they always say this, I don’t want to bother you. They’re like, I know you’re so busy, and I’m like, yeah, I’m really busy. But so are you. And you’re seeing me for a reason, and that’s my job. And if you don’t tell me, there’s no way I’m going to know because and we’ll laugh because I’ll stay like, I’m not following you around. I’m like, I don’t have a little camera attached where I can see you have something new growing on you. I just don’t know. And so you have to tell me. So especially during covet and stuff. Sometimes it’s hard to reach me, like some of my patients, the phone number wasn’t working, just logistical things that are just horrible. So I think that there are a lot of barriers in health care, including my own number that I gave to them about working. And it’s like, yeah, I’m sorry. You just have to keep trying, and I will do. But don’t not do it because you think you’re bothering me. And really, I’ll tell them if you really think that I’m too busy for you, then right. You have to find another doctor who doesn’t give you that feeling because otherwise you’re not getting the right care that you need.

Rob Oliver: That’s a super powerful statement to make. What excites you about the future of healthcare?

Christine Ko: So I think what excites me is a couple of things. One is this concept of patient centered care, or another term for it is relationship centered care, where patients are, especially with the Internet. And now I think it’s hit the streets maybe or about to Google Docs or something like that where patients it might only be for maybe it’s called Google skin, but you can put in a couple of symptoms and sort of the computer will generate a diagnosis for you. So in some ways, I’m a little worried about it, but in some ways, I think and the Cares Act, which is meaning that patients can get their results right away. And also as a physician, I am concerned about that as well. I think it’s a powerful thing, but also can be very detrimental. And what I mean by that is all of the patient centered care, relationship centered care, the cures act, where you should have access to your results pretty much as soon as they’re available. And the Internet, you know, and sort of being able to search things yourself. I think all of that is great because it puts power in the patient’s hand. And you’re the one as a parent of a patient, you’re the one who is most affected by that on a daily basis. And the doctors don’t necessarily know, including me, what it’s like to live in your shoes with that disease or the symptoms or whatever, you know. And sometimes the diagnose is wrong. And if you could tell me the symptoms in a way that I hear it for sure, maybe I would know. Yeah, you don’t have the right diagnosis, but the problems that I see with that not so much patient centered in relationship center care, because that’s still the doctors there with you, right. And so together as a partnership, you can interpret things and come to conclusions. But the crack where you get the results ASAP and the Internet, I used to always cringe when patients would tell me I looked it up, I did an Internet search, and then I’ve done it now for my son any time. And the Cures Act has already hit us here, and they don’t know what to do with their results. So then the doctor’s office is bombarded with calls like, what does this mean? What does this mean? And patients are very anxious, right? Because I don’t know what it means. And so I was effective, for example, in sort of a positive and negative way by this, for example. So my son had some genetic testing long ago, and for whatever reason, the result was mailed to me. So I got it without any expectation by the doctor. This is years ago before the Cures Act. So it says if the Cures Act is in effect and I just get the result. I had no idea what to do with it. I looked it up on the internet, but there wasn’t really any information about it. So I put a call into the geneticist, and I just said, what does this mean? And I had to wait a couple of days. And so it may be nervous. I don’t know that anything could be done about that, but I think it’s hard when you just want to know and the doctor is not going to be able to call you back right away. So I don’t I’m sort of agnostic on that right now. I don’t know if it’s better to have that in your hand and just be puzzled about it and anxious about it for a couple of days, or if it’s better for the doctor to hang on to it and then tell you so I don’t know. But I think that’s going to arise when you don’t know how to interpret it. You’re going to be anxious sometimes, and no one’s going to be there to hold your hand right away. And some patients have told me that when they have a significant diagnosis, usually of some kind of cancer, they don’t want me to tell some of them don’t want me to tell them over the phone. They’re like, no, I want to come see you. I want to be in the office. And so I think it just feels like they feel better that they’re not as alone. So it’s hard because I think different patients are going to feel different about it. Different parents are going to feel different about it. And different doctors are going to feel different about that. But the other on the flip side, the power of the internet. My son that diagnosed of auditor neuropathy. So he was diagnosed late, but at 13 months of age, I still remember this because not to beat myself or anyone else up about it. But it’s just a perfect example, I said at that time, I asked as the doctors leaving the room, I said, yeah, but it just seems like he can hear sometimes and not others, which to me at the time I was able to can hear. Sometimes it means you can hear, but actually, auditor neuropathy is exactly that you can hear sometimes and you can’t hear others. It’s like a radio station coming in and out of static. And at the time I remember she’s walking out the door and she says to me, Well, there’s auditor neuropathy, but that’s so rare. And you would need a completely different test that to make that diagnosis, which she hasn’t had yet. But do you want them to go under Anette general anesthesia? And so I just said, no, I don’t want him to go under general anesthesia. So. But that was the question to ask me. It was more like, do you want to get the right diagnosis for your son? Then I would say, yes. So it was just sort of a confusing thing. And there was some bias and authority bias. I was like, oh, was she saying it’s so rare? It doesn’t matter. But had I looked it up, you know, when I went home because I didn’t, I just I trusted. And I think I was like, I don’t want him to get General Anesthesia because I knew the risks. And then I think my health care experience was a detriment where I was like, General Anesthesia is not good for a little kid if he doesn’t need it. So I was like, no, I don’t want him to get General Anesthesia. So then I don’t want him to get that test. But it was then. But had she phrased it differently? Like, do you want the right diagnosis? Given what you just said, hearing that is fluctuating auditor neuropathy as possible? Do you want to see if that’s the correct diagnosis? I would have said yes. And then I would have gone home and looked it up, and I would have known this is what my son has, because when I read about it and trust a good site, I was like, yeah, everything they describe, I was like, yes, this is him. Sure. So I think sometimes when your disease matches the textbook, well, we call it reading the textbook, which not everyone who does when you get to a good site and you read about it, you’ll know, this is what I have. So I think in that sense, there’s power and knowledge and the internet. So I think that’s exciting. But it’s sort of like I just described it’s a double edged sword.

Rob Oliver: It’s exactly the phrase I was going to use. It’s a double edged sword that puts some power in your hands. But it sometimes leaves you a loan to deal with the fallout from what you’re getting. What is one thing that medical professionals can start doing today to improve the quality of healthcare?

Christine Ko: So this has worked for me. And I’m happy to say my husband is a physician as well. And he tried it out. And he says it transformed his practice as well. So I think it sounds really simple, but I think eye contact and everyone says that right. Just make eye contact. And I think I would I don’t know. Maybe I used to try to do it as well, but what worked for me is actually in order to try to make eye contact, my trick is figure out what color someone’s eyes are. Wow. So when I walk into the room now as a reminder to myself to try to connect, I’m always like, you know, the first thing I do, it sort of have it now. I don’t have to think about it like I used to have to what’s their icon like? Look, you know, and I would I would literally be forcing myself to look because when you walk into the room and especially if it’s a new patient. There’s a lot of stuff going on. If I’m running late and then we have epic. Now we have our medical record system and you have to type a way to log in right away. Like, there’s all this stuff. It’s like more and more. So the patient just sort of gets ignored, not necessarily intentionally. You know, it’s just sort of because I’m typing away and I can’t log in today. I don’t know. And so thing to sort of walk in first and be like, okay, I remember, you know, like I said, not have it. What color are their eyes? And then it’s interesting. My husband put it this way. He was sort of like, it’s transformative because he looks and he notes. And it just really it takes like, some people eye color is hard. You know, it’s like, well, is it war? But, you know, 5 seconds at most, right? And he’s like, and then you’ll tend to smile because you’re like looking at someone’s eyes and you’re looking at their face. It even works with COVID with the masks. That’s great. And he says, and then, you know, without really thinking about you smile and the patient smiles. And it’s just so much better than walking in computer log in and typing way. And what’s the problem today? It’s just totally different.

Rob Oliver: It goes back to what you were talking about earlier with making that patient practitioner connection and wonderful. Christine Ko, you have been so open and so willing to share. Thank you so much for being here, and I really appreciate your perspective on healthcare.

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